Browsing by Author "Morey, Miriam"

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    ItemOpen Access
    Assessing Feasibility of a Focused Geriatric Assessment in Older Adults with Sickle Cell Disease to Address Functional Risk Factors for Morbidity and Mortality
    (Blood, 2019-11-13) Oyedeji, Charity I; Pieper, Carl; Hall, Katherine; Morey, Miriam; Whitson, Heather; Strouse, John J
    Background During the last five decades the life expectancy for people living with sickle cell disease (SCD) has improved markedly, with median survival of 61 years in recent cohorts enrolled from academic centers. Older adults with SCD (defined herein as age ≥ 50 years) make up 13% of the adult population at four major academic medical health systems in North and South Carolina. As this population continues to grow, more data are needed to guide medical management appropriate to their needs, as a lifetime of vaso-occlusion often leads to functional decline and premature development of complications seen in geriatric populations. There are no validated assessment tools and interventions to improve physical function in older adults with SCD. In this study we evaluated the feasibility of a focused geriatric assessment (FGA) for older adults with SCD. Methods Twenty adults with SCD ≥ 50 years old were enrolled in a prospective cohort study. Measures previously validated in the oncology FGA were included and enriched with additional physical and cognitive functional measures. Activity monitoring was performed for 7 days using the Actigraph wT3X-BT, and biomarkers were collected at each study visit (baseline, 10-20 days after a hospitalization [for those who experienced a hospitalization during the study period] and 12-month after baseline). The primary endpoint was the proportion of subjects who complete the assessment. Secondary endpoints were duration of the FGA, proportion who completed the activity monitoring and lab collection, and acceptability. Results Twenty-one of 25 older adults approached for the study consented. Nearly all (20/21, 95%) completed the FGA. One was removed after missed study visits. The median duration of the assessment was 97 minutes (range 73-175 minutes), and there were no adverse events. The mean age was 57 years (range 50-71), 50% (10) were female, 30% (6) were on disability and 50% (10) were working. 45% (9) were former smokers but only 5% (1) were current smokers (Table). On the acceptability survey, 95% (19) reported the length of the assessment as appropriate. 10% (2) subjects reported a portion of the Montreal Cognitive Assessment (MoCA) as difficult. No subject found the questions upsetting, and 2 subjects reported that they would remove redundant questions. All subjects had a Karnofsky Performance Score of at least 80% and were able to complete activities of daily living. A third (35%) had been admitted in the last 6 months, and most (75%) had had severe pain crises at home that limited their activity. 40% (8) had > 4 severe crises at home in the last 6 months. The mean usual gait speed was 1.14 m/sec (range 0.90-1.50) (Figure). Mean Timed Up and Go (TUG) was 10.1 seconds (range 7.7-14.0). Two (10%) subjects had a TUG consistent with increased fall risk (≥ 12 seconds). Mean grip strength of the dominant hand was 39 kg (range 22-54 kg) for males and 25 kg (range 20-34 kg) for females, which is 38% and 43% lower than expected for age and gender. Mean six-minute walk (6MW) was 465m for males and 499m for females, which is 22% and 4% lower than expected for age/gender/height/weight. In the 17 subjects with heart rate recovery (HRR) recorded after 6MW, the mean HRR at 1 minute (HRR1) was 20 bpm (range 0-46). 31% of tested subjects had a HRR1 consistent with impaired HRR (12 bpm or fewer). HRR negatively correlated with age (HRR1 B=-1.1; 95% CI -0.2 - -2; p<0.05). Half of the subjects had mild cognitive impairment (MoCA score < 26). MoCA scores correlated with literacy testing (B= 0.39; 95% CI 0.10-0.68; p=0.02). The first 12 subjects wore the activity monitor 6 days (range 4-8 days) for an average of 15 hours a day. Average activity was sedentary for 7 hours (47%), light 7.5 hours (50%), and moderate 1 hour (7%) per day. There was a median of 7070 steps/day. Conclusions We found FGA to be feasible, acceptable, and safe. The duration of the FGA in our population was 3 times longer than the FGA for oncology. One of our most remarkable findings is that the older adults with SCD in this study have a physical function similar to non-SCD adults over the age of 80. They also demonstrate impaired HRR, an independent predictor of mortality in the elderly. After completion of the 12-month follow-up assessments, we will develop a briefer assessment to be evaluated in a larger study. Future steps will be to determine if FGA can predict outcomes such as risk of hospitalization and mortality and to develop interventions to improve these outcomes. Disclosures Strouse: Global Blood Therapeutics: Consultancy.
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    Is objective mobility data associated with pharmacologic venous thromboembolism (VTE) prophylaxis use among hospitalized older adults?
    (Journal of Hospital Medicine, 2018-04-10) Pavon, Juliessa; Sloane, R; Pieper, Carl; Colon-Emeric, Cathleen; Gallagher, David; Cohen, Harvey; Hall, K; Morey, Miriam; McCarty, Midori; Ortel, Thomas; Hastings, Susan
    Background: Clinical practice guidelines state that mobility is supposed to play an important role in determining use and duration of pharmacologic VTE prophylaxis. This study examines whether measured mobility levels relate to pharmacologic VTE prophylaxis use among hospitalized older adults. Methods: Prospective observational data from a sample of community-dwelling older adults aged ≥ 60 years, admitted to an academic hospital’s general medicine service. Inpatient mobility was objectively measured using ankle-mounted accelerometers from admission until discharge (or ≤ 7 days). Clinical and demographic factors, and pharmacologic VTE prophylaxis use was manually abstracted from the medical record. We performed descriptive statistics for daily mobility parameters (time spent in activity, sedentary time, and step counts) according to VTE risk stratification using a validated stratification tool (Padua Score) and prophylaxis use. Pearson’s correlation was used to determine the correlation of mobility measures with use and duration of VTE prophylaxis. Results: Among hospitalized older adults in this sample (N=65), 71% (n=46) were low risk for VTE occurrence, yet 62% (n=40) received pharmacological VTE prophylaxis during an average of 57% of their hospital stay (SD 46). Median time in activity was 65 minutes/day (IQR 40, 102; Range 5 – 289 mins/day). Median time spent in sedentary activity (awake but not moving) was 15 hrs/day (IQR 12, 17; Range: 3 – 20 hrs/day). Median total daily steps was 1370 (IQR 852, 2387; Range: 86 – 6134 steps/day). There was significantly greater sedentary time (16 hrs/day) for high risk patients compared to low risk patients (13 hrs/day) (p=0.02), but no differences in activity time or step counts. There were no detectable differences in mobility measures between those receiving and not receiving pharmacological VTE prophylaxis, and no significant correlations between mobility measures and duration of VTE prophylaxis. Conclusions: Among hospitalized older adults, use and duration of VTE prophylaxis did not differ by higher or lower mobility activity, suggesting that better mobility awareness is needed to guide appropriate pharmacological VTE prophylaxis use.
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    Telemedicine cardiovascular risk reduction in veterans.
    (American heart journal, 2013-04) Melnyk, S Dee; Zullig, Leah L; McCant, Felicia; Danus, Susanne; Oddone, Eugene; Bastian, Lori; Olsen, Maren; Stechuchak, Karen M; Edelman, David; Rakley, Susan; Morey, Miriam; Bosworth, Hayden B

    Background

    Patients with co-occurrence of hypertension, hyperlipidemia, and diabetes have an increased risk of cardiovascular disease (CVD) events. Comprehensive programs addressing both tailored patient self-management and pharmacotherapy are needed to address barriers to optimal cardiovascular risk reduction. We are examining a Clinical pharmacy specialist-, telephone-administered intervention, relying on home monitoring, with a goal of providing tailored medication and behavioral intervention to Veterans with CVD risk.

    Methods

    Randomized controlled trial including patients with hypertension (blood pressure >150/100 mm Hg) or elevated low density liporotein (>130 mg/dL). Longitudinal changes in CVD risk profile and improvement in health behaviors over time will be examined.

    Conclusion

    Given the national prevalence of CVD and the dismal rates of risk factor control, intensive but easily disseminated interventions are required to treat this epidemic. This study will be an important step in testing the effectiveness of a behavioral and medication intervention to improve CVD control among Veterans.